What Is Fecal Incontinence?
Fecal, or bowel, incontinence is the inability to regulate bowel
movements. It can be common among the elderly. Accidental bowel leakage
is typically not an indication of something serious. However, it can
affect daily life and a person’s self-confidence. Effective treatments
used at the office can include:
What Causes Bowel Incontinence?
The most frequent cause of bowel incontinence is an injury to the
muscles surrounding the anus. Vaginal childbirth and anal surgery can
damage the anal sphincters, or their nerves, which can cause the
condition. Other causes can include:
Diarrhea- frequently due to an infection or irritable bowel syndrome
(IBS)
Impacted stool- due to serious constipation
Inflammatory bowel disease- such as Crohn's disease and ulcerative
colitis
Nerve damage- this may be caused by spinal cord injury, multiple
sclerosis, and diabetes
Radiation damage to the rectum- such as that following prostate
cancer treatment
Cognitive impairment- seen following a stroke or progressed
Alzheimer's disease
Multiple causes often affect the person and occasionally there may not
be a clear cause.
How Is Bowel Incontinence Diagnosed?
Discussing the problem can be a little strange but it will be helpful to
remember that the doctor is there to help. To make sure that the right
treatments are used, the doctor may perform a physical examination of
the strength of the anal sphincter. Other tests can include:
Stool testing- stool testing can identify an infection
Endoscopy- A tube with a camera is inserted into the anus to
identify any potential issues in the anal canal or colon.
Anorectal manometry- A pressure monitor is directed into the anus
and rectum to measure the strength of the sphincter muscles.
Endosonography- An ultrasound probe is inserted into the anus which
generates images which can identify issues in the anal and rectal
walls.
Nerve tests- This can test the reaction of the nerves which control
the sphincter muscles to diagnose nerve damage.
MRI defecography- Magnetic resonance imaging can be done on the
pelvis, possibly when the patient is moving the bowels on a special
commode. This offers information about the muscles and supporting
structures of the pelvis, anus, and rectum.
How Severity Of Fecal Incontinence Measure?
Many scroring systems are used to measure the severity like Jorge-
Wexner incontinence score.
What Are The Treatment Options For Bowel Incontinence?
Medications
Depending on the cause of fecal incontinence, options include:
Anti-diarrheal medications like loperamide (Imodium) and those
containing diphenoxylate and atropine (Lomotil).
Bulk laxatives such as methylcellulose (Citrucel) and psyllium
(Metamucil)
Exercise and physical therapies
Like:
Kegel exercises
Kegel exercises help to strengthen the pelvic floor muscles. These
muscles support the bladder and bowel and in women, the uterus.
Strengthening these muscles may help reduce incontinence of stools.
Biofeedback
Specially pelvic floor trained physical therapists teach simple
exercises that can increase anal muscle strength to
-Strengthen pelvic floor muscles.
-Sense when stool is ready to be released.
-Contract the muscles if having a bowel movement at a certain time is
Bowel training
Your doctor may recommend making a conscious effort to have a bowel
movement at a specific time of day: for example, after eating.
Surgical Treatment Options:
Sacral nerve stimulation
The sacral nerves run from your spinal cord to muscles in the pelvis.
They regulate the sensation and strength of your rectal and anal
sphincter muscles. Implanting a device that sends small electrical
impulses to the nerves can strengthen muscles in the bowel.
Surgery
Treating fecal incontinence may require surgery to correct an underlying
problem, such as rectal prolapse or sphincter damage caused by
childbirth. The options include:
Sphincteroplasty: This procedure repairs a damaged or weakened anal
sphincter that occurred during childbirth. Doctors identify an injured
area of muscle and free its edges from the surrounding tissue and bring
the muscle edges back together and sew them in an overlapping fashion.
This helps strengthen the muscle and tighten the sphincter.
Sphincteroplasty may be an option for people trying to avoid colostomy.
Treating rectal prolapse, a rectocele or hemorrhoids: Surgical
correction of these problems will likely reduce or eliminate fecal
incontinence. The longer the prolapse goes untreated, the higher will be
the risk of fecal incontinence not resolving after surgery.
Colostomy, also called bowel diversion. This surgery diverts stool
through an opening in the abdomen. Doctors attach a special bag to this
opening to collect the stool. Colostomy is generally considered only
after other treatments haven't been successful.
